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ARTICLE · 08 JUNE 2023

California Assembly Acts To Streamline Physician Credentialing Process

Manatt, Phelps & Phillips, LLP
Manatt, Phelps & Phillips, LLP
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The California Legislature is considering a bill to simplify the process by which health insurers and plans credential providers. Currently, providers must satisfy the proprietary...

United StatesGovernment, Public Sector
Sharon L. Woda
Sharon L. Woda
McKay S. Carney
McKay S. Carney
Thomas R. McMorrow
Thomas R. McMorrow

The California Legislature is considering a bill to simplify the process by which health insurers and plans credential providers. Currently, providers must satisfy the proprietary "credentialing" requirements of individual insurers/plans to contract with them. This generally requires submitting the same information, such as licensure, education and work history information, to each health insurer/plan, but doing so in compliance with the unique process of each.

New Credentialing Process

The chair of the California Assembly's Health Committee, Jim Wood, introduced a bill to streamline the credentialing process earlier this year. His Assembly Bill 815 would require that the California Health and Human Services Agency (CalHHS) stand up a new state board by July 1, 2024, to certify private and public entities to credential providers by July 1, 2025. Providers that are credentialed by a certified entity would be deemed qualified to contract with insurers and plans

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